Effects of urinary incontinence on psychosocial outcomes in adolescence

Objective: To examine whether daytime wetting and bedwetting (urinary incontinence: UI) in childhood and adolescence are associated with psychosocial problems in adolescence. Method: We used data from the Avon Longitudinal Study of Parents and Children to examine the association between trajectories of UI from 4–9 years and self-reported psychosocial problems in adolescence (13-14 years) including depressive symptoms, peer victimization, poor self-image and school experiences (negative perception of school and teachers, problems with peer relationships). Sample sizes ranged from 5,162 (perception of teachers) to 5,887 (self-image). We also examined associations between self-reported UI at 14 years and psychosocial problems. Results: Relative to normative development, adolescents who experienced delayed development of bladder control had poorer self-image (standardized mean difference= 0.18 [95% CI= 0.04, 0.32]), more negative perceptions of school (0.18 [0.02, 0.34]) and more problems with peer relationships at school (0.25 [0.10, 0.40]). Persistent wetting (bedwetting with daytime wetting) in childhood was associated with increased problems with peer relationships in adolescence (0.19 [0.03, 0.34]). The strongest associations between adolescent UI and psychosocial problems were found for daytime wetting (reference= no UI at 14 years): depressive symptoms (OR= 3.04 [95% CI: 1.91-4.84]), peer victimization (2.14 [1.48-3.10]), poor self-image (t=-8.49, p<0.001) and problems with peer relationships (t=-4.69, p<0.001). Conclusions: Children with delayed development of bladder control and persistent wetting have increased psychosocial problems in adolescence. Adolescents with UI reported a range of psychosocial problems and clinicians should be aware that they might require support from psychological services.